Hip Pain and how to prevent it

Most hip pain has a very simple explanation, for example if you’ve overdone it while exercising. The pain is usually caused by strained or inflamed soft tissues such as tendons, and it often clears up within a few days. Athletes who play active sports like football, soccer, and rugby are more prone to suffering through a hip injury than athletes in other sports; however,hip injuries can also occur by accident, whether through a bad fall or quick and awkward movement. Long-term hip pain can be caused by specific conditions such as osteoarthritis.

Pain caused by a problem in the hip joint can be felt in the groin, down the front of the leg and in the knee. Sometimes knee pain is the only sign of a hip problem. This is called referred pain, and it’s fairly common. Hip pain can also be felt in the buttock (although pain in this area can also be caused by problems with the lower back) or on the outside of the hip.

Anatomy of the Area

The hip joint is located where the thigh bone (femur) pelvic bone. It is a “ball and socket” joint. This arrangement gives the hip a large amount of motion needed for daily activities like walking,squatting, and stair-climbing.

BONES AND JOINTS

The bones of the hip are the femur (the thighbone) and the pelvis. The top end of the femur is rounded and is the ‘ball’ of the ball and socket joint. This ball is called the femoral head. The femoral head fits into a round ‘socket’ on the side of the pelvis. This socket is called the acetabulum.

The femoral head is attached to the rest of the femur by a short section of bone called the femoral neck. A large bump juts outward from the top of the femur, next to the femoral neck. This bump, called the greatertrochanter, can be felt along the side of your hip. Large and important muscles connect to the greater trochanter. One muscle is the gluteus medius. It is a key muscle for keeping the pelvis level as you walk.

Articular cartilage is the material that covers the ends of the bones of any joint. Articular cartilage is about one-quarter of an inch thick in the large, weight-bearing joints like the hip. Articular cartilage is white and shiny and has a rubbery consistency. It is slippery, which allows the joint surfaces to slide against one another without causing any damage. The function of articular cartilage is to absorb shock and provide an extremely smooth surface to make motion easier.

In the hip, articular cartilage covers the end of the femur and the socket portion of the acetabulum in the pelvis. The cartilage is especially thick in the back part of the socket, as this is where most of the force occurs during walking and running.

LIGAMENTS

There are several important ligaments in the hip. Ligamentsare soft tissue structures that connect bones to bones, creating the stablejoint. A joint capsule is a watertight fibrous sac that surrounds a joint. Thecapsule is lined by the synovium, which produces a fluid (synovial fluid) thatnourishes the cartilage and lubricates the joint. In the hip, the joint capsuleis formed by a group of three strong ligaments that connect the femoral head tothe acetabulum. These ligaments are the main source of stability for the hip.They help hold the hip in place.

A small ligament connects the very tip of the femoral headto the acetabulum. This ligament, called the ligamentum teres, doesn’t play arole in controlling hip movement like the main hip ligaments. It does, however,have a small artery within the ligament that brings a very small but importantblood supply to part of the femoral head.

A special type of ligament forms a unique structure insidethe hip called the labrum. The labrum is attached almost completely around theedge of the acetabulum. The shape and the way the labrum is attached create adeeper cup for the acetabulum socket therefore providing more stability. Thissmall rim of cartilage can be injured and cause pain and clicking in the hip.

MUSCLES AND TENDONS

Hip muscles are bodies of tissue that produce motion in thehip when stimulated. They also work to stabilise the hip, supporting theligaments. The hip is surrounded by thick muscles. The gluteals make up themuscles of the buttocks on the back of the hip contributing to extending thehip backwards and abducting it (pull the leg outwards away from the other leg).The inner thigh is formed by the adductor muscles. The main action of theadductors is to pull the leg inward toward the other leg.

The muscles that flex the hip forwards are in front of thehip joint. These include the iliopsoas muscle. This deep muscle begins in thelow back and pelvis and connects on the inside edge of the upper femur. Anotherlarge hip flexor is the rectus femoris. The rectus femoris is one of thequadriceps muscles, the largest group of muscles on the front of the thigh.Smaller muscles going from the pelvis to the hip, help to stabilize and rotatethe hip.

The hamstring muscles that run down the back of the thighstart on the bottom of the pelvis. Because the hamstrings cross the back of thehip joint on their way to the knee, they help to extend the hip, pulling itbackwards.

A long tendon band runs alongside the femur from the hip tothe knee. This is the iliotibial band. It gives a connecting point for severalhip muscles. A tight iliotibial band can cause hip and knee problems.

NERVES

All of the nerves that travel down the thigh pass by thehip. The main nerves are the femoral nerve in front and the sciatic nerve inback of the hip. A smaller nerve, called the obturator nerve, also goes to thehip.

These nerves carry the signals from the brain to the musclesthat move the hip. The nerves also carry signals back to the brain aboutsensations such as touch, pain, and temperature.

Potential Causes ofHip Pain and how to prevent it

OSTEOARTHRITIS

Osteoarthritis which is sometimes called joint ‘wear andtear’ is common and mainly damages the joint cartilage, but there is often someinflammation as well. It usually affects only one or two major weight bearingjoints.

It is one of the most common causes of hip pain in adults.Although it can often occur randomly, it’s often linked to earlier fractures,trauma or childhood hip problems. Changes in the movement and alignment of thehip eventually lead to wear and tear on the joint surfaces. We don’t yet fullyunderstand why osteoarthritis develops without any pre-existing problems, butit can cause a great deal of pain, restricted movement and a limp. In extremesituations, the leg can become shorter and the hip can become fixed in a bentposition, making mobility significantly worse.

In osteoarthritis of the hip the cartilage cushion is eitherthinner than normal (leaving bare spots on the bone), or completely absent.Bare bone on the head of the femur grinding against the bone of the pelvicsocket causes mechanical pain. Small outgrowths called bone spurs orosteophytes may form in the joint. Fragments of cartilage floating in the jointmay cause inflammation in the joint lining, and this is a second source ofpain. X-rays show the “joint space” to be narrowed and irregular in outline. Anx-ray of the normal hip joint usually shows a “space” between the ball and thesocket because the cartilage does not show up on x-rays.

TROCHANTERIC BURSITIS

Where friction occurs between muscles, tendons, and bones,there is usually a structure called a bursa. A bursa is a thin sac of tissuethat contains fluid to lubricate the area and reduce friction. The bursa is anormal structure. The body will even produce a bursa in response to friction.Sometimes a bursa can become inflamed (swollen and irritated) because of toomuch friction or because of an injury to the bursa. An inflamed bursa can causepain because movement makes the structures around the bursa rub against it.

A common spot for bursitis is on the side of the hip. Here alarge tendon passes over the bony bump on the side of the hip. The bony bump iscalled the greater trochanter. Inflammation in the bursa between the tendon andthe greater trochanter is called trochanteric bursitis. Friction can start ifthe outer hip muscle (gluteus medius) is weak, if one leg is longer than theother, or if you run on banked (slanted) surfaces. This problem is common inolder individuals. It may also occur in younger patients who are extremelyactive in exercises such as walking, running, or biking.

TORN ACETABULAR LABRUM

The acetabular labrum is a thick ring of cartilage aroundthe hip socket. It can be torn if the ball or socket of the hip is deformed.This can be the result of hip problems in childhood or changes to the shape ofthe hip as it develops, but in most cases the cause is unknown. Hip jointdeformities are called cam lesions when the ball is affected and pincer lesionswhen the socket is affected.

AVASCULAR NECROSIS (OSTEONECROSIS)

Avascular necrosis is a condition that causes hip pain inyoung-to-middle-age adults. It’s often referred to as idiopathic, which meansthat it doesn’t have any clear cause. However, it’s also linked with thefollowing:

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drinking too much alcohol

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using steroids

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sickle cell disease

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radiotherapy

Avascular necrosis can occur when the blood supply to theball of the hip (the femoral head) is lost. This causes the bone tissue to dieand the femoral head to collapse, which results in arthritis. If your doctorthinks you have avascular necrosis, it’s important that they refer you for anurgent MRI scan to confirm the diagnosis. As soon as you have a diagnosis, youcan start treatment, which may stop the condition progressing and prevent arthritisdeveloping.

HIP FRACTURES

A fall onto the hip can result in a fracture. Most commonlythis would happen in the elderly population and be in the neck of the femur. Ifthe fracture is out of place it requires fixing to make the hip stable and thismight be done with pins and screws or possibly with a full or partial hipreplacement. If however the fracture is stable it might be allowed to healnaturally and this would mean walking with crutches for 4 weeks graduallytaking more weight on the leg the more comfortable and strong it feels.

HIP PAIN THAT ISREFERRED FROM THE BACK, OR LOCAL MUSCLES

The nerves from the lower part of the back supply musclesthat control the hip. A pinched nerve in the lower spine or the related musclescan cause pain to go down the front of the leg from the groin to the knee andmake it feel like a hip pain.

The muscle that flexes the hip is called the psoas muscleand it has a nerve supply from the femoral nerve. The gluteus maximus muscle extends the hip as you walk so that you can propel yourself forward and the gluteus medius muscle keeps the pelvis level when you stand on one leg. Theseare the spots where you might feel pain coming via the nerves that supply thesemuscles.

POOR BIOMECHANICS

Changes in the movement and alignment of the hip eventuallylead to wear and tear on the joint surfaces.

i.The muscles of the hip being weak. A weakness o fthe muscles that pull the hip out and away from the other leg, or turn thethigh outward (hip abductor and external rotator muscles,) can lead to imbalances in the alignment of the entire leg including the knee

If you feel this is an issue, strengthen your hip muscles (use the exercises within this sheet) to correct the imbalance

If you feel that this is an issue, ensure adequate length of muscles and good range of movement at the knee by undertaking a regular stretching programme (use the stretches provided)

iii.Poor foot control – flat feet or feet rolling inwards causes inward rotation of the leg and therefore poor positioning of the hip

If you feel that this is an issue for you please visit your GP, chartered physiotherapist or podiatrist to receive an expert opinion and appropriate intervention.

ACTIVITIES

i.A sudden change in the type, nature or loading of an activity can cause hip pain. This can also be affected by inappropriate clothing, accessories, surfaces and force generated.

ii.A sudden introduction or escalation in hill /stair activity

Walk up stairs leading with your unaffected (pain free) leg, walk downstairs leading with your affected (painful) leg. This can be remembered easily by the saying ‘the good leg goes up to Heaven, the bad leg goes down to Hell’

Graduate or phase the increase in the activity. If this is not possible within a work environment make use of escalators / lifts where possible and reduce over time to create the phased approach

Take regular short breaks and when safe to do so, walk backwards to change the bio mechanical loading on your hip

iii.A sudden introduction or escalation in Squatting

Try to raise the cause of your need to squat to waist height e.g. use raised beds in a garden / garden centre or place a case / box onto a higher workbench

Use a low chair / stool where possible e.g. a teacher bending down at the side of a young child at school when he/she needs help in the classroom

Kneel using kneeling pads and alternate the kneeling position / leg

iv.Cycling with your saddle at the incorrect height and putting the pedal in your instep rather than on the ball of your foot

Wear suitable clothing for the activity that allows a good leg position

iii.Weight (Loading the hip). Being overweight(increased Body Mass Index) is a very significant contributing factor

Reduce stress on the hip by losing weight. Please seek medical /professional advice if you feel that you need dietary advice. Undertake gentle reduced weight bearing activity to aid weight reduction such as swimming or walking waist deep in a swimming pool, undertaking an upper limb work out while seated etc.

Signs and Symptoms of Hip Pain

Symptoms from hip problems vary. They depend on a person’s condition and which structures are affected. Some of the more common symptoms of hip problems are:

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hip pain / stiffness

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pain spreading into the back, groin, buttock and thigh regions

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pain radiating from the hip into the knee

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pain causing a limp

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pain accompanied by locking, catching, clicking

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pain upon weight bearing, sitting for long periods, walking or pivoting on the leg

Aiding Recovery with a Home Programme

When suffering from hip pain, it is recommended that you remain as active as your pain will comfortably allow and continue your daily activities as normal. Obviously if these activities are adding to the pain then modify or do not continue them, but getting back to work and keeping the area moving is often the best way to minimise the pain and aid recovery.

A reported study in the Annals of Internal Medicine (1992)suggests that people with osteoarthritis of the hip who remain active generally do better in the long run than those who ‘baby’ themselves. Also being totally sedentary leads to loss of muscle and bone strength which adds to the problem.

First Aid advice(immediately after a hip injury)

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Pain relieving medication should help with the discomfort.Anti-inflammatory medications can help ease pain and swelling and get people back to activity sooner. These medications include common over-the-counter drugs such as ibuprofen. Talk to your doctor or pharmacist if you have specific questions about which pain reliever is right for you. Also see your GP if over the counter medication is not easing your pain after a day or two

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Apply hot or cold packs to the painful area. You may decide which the best approach is for you. You can buy hot and cold packs from www.Vivomed.com, but you can also use a hot water bottle or bags of ice or frozen peas (wrapped in a damp tea towel) will often be as good. Both approaches help to reduce the pain sensation, but they also help to increase the blood flow to the area which brings oxygen and nutrients to the tissues to help them heal more quickly.

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Ice pack to be applied to the region for approximately 20 minutes every 2 hours. It is advised that you check the skin every 5-10 minutes to avoid the possibility of an ice burn from the cold temperature. Apply frequently in the first 2 days

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Hot water bottle to be applied for at least 20 minutes every 2 hours, if in severe pain avoid a hot bath in case you cannot get out of it.

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Position yourself in the most comfortable position and postures but try to change position every 30 minutes. For further detail seethe postural advice in this leaflet

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Attempt gentle walking and movement to prevent ceasing up,if too painful use a walking stick or crutches to keep moving but reducing the load through the hip

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Sleep in the most naturally comfortable position on a comfortable surface. The best sleeping posture is lying either on your side or on your back. Support your hip with a pillow between your legs if side lying,or under your knees if lying on your back

Further Self-Help for when you are in Pain

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Use heat or ice in the form of hot baths, hot water bottles,heat or ice packs (20 minutes minimum duration)

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Be aware of hip positions and postures at work and home. The positions in which you work and relax each day have a great impact on the health of your hip. It is easy to compensate and allow yourself to develop poor postural habits. You will need to be consciously aware of postures and positions when you are performing tasks at home and work

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Think about how you are sitting in all situations

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Keep your legs moving when you are sitting down

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Ensure that your workstation is not cluttered and that you can stretch out your legs while you sit

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Do not sit cross legged

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Raise your seat so that your hip is only bent to 90 degrees and it is easier to transition into sitting or standing

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Driving the car: if this increases the pain, alter the seat distance from the pedals, seat height, back rest angle to see if a change of hip position or increasing the use of your feet rather than using your whole leg to use the pedals . Park with plenty of room to access and exit the vehicle with the door fully open to allow you to access the vehicle bottom first while stood on both legs, and exit it feet first with both feet concurrently

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Think about your standing posture, whether working at benches in your job or for household activities, be aware of your posture,symmetrical weight bearing, the surface on which you are standing and you rfootwear

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Ensure the bench height allows you to work with a straight back, plenty of room for your feet (no twisting or reaching) and shoulders and arms relaxed

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Have objects close to you to avoid unnecessary reaching

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The standing surface should be cushioned (not just hard wood / concrete / tiles) and wear cushioned soles to your footwear. This reduces force and loading of your hip

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As much as sitting in one position is not good, prolonged standing can be fatiguing. Try to do some of your work while sitting, alternate your work or household tasks to vary your position

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Think about Lifting and Carrying

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Think before you lift. Test the weight. Avoid reaching to lift objects or lifting awkwardly. Carry the object close to your body

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When lifting from ground level, stand close to the object with feet apart, bend using your knees and your back (about 50:50). Keep your chin in during the lift. Think silver back gorilla posture!

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Carry fewer bags of groceries from the car at a time. There will be more trips but less strain on your hip

When travelling, always use a suitcase with wheels,including hand luggage. Consider whether you need all those items that you have packed, especially footwear, which is heavy - lessen the load

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When going to and from work, carry your laptop or papers in a rucksack. Do not use a briefcase, or if you insist on not using a rucksack,alternate the side you carry your briefcase or laptop. If you need to carry extra paperwork, consider transporting it separately. Do not overload one side

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Specially designed laptop rucksacks are a more comfortable way of carrying computers

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Use a trolley to carry over sized or multiple items. At the supermarket, choose a trolley that steers easily when you push it

When nursing or breastfeeding a baby, place the baby on a pillow on your lap to save having to hold the weight of the baby for prolonged periods

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Encourage children to climb onto your lap or into the car as soon as they are able Position their car seat to limit the amount of reaching you have to do to secure the child in the seat

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Household Activities

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Spread chores out over a few days. You don’t have to do all the household tasks at once. Change your routine and reduce the chance of hip strain

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Rotate the cleaning tasks and don’t do the same task all at once. Alternate lighter tasks with heavier tasks. For example, dust, hoover one room, do the washing up, and vacuum another room. Take breaks between each task. You do not have to do everything at once – be adaptable and pace yourself

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When laundering, lift fewer clothes from the washing machine at once. Place the basket up on a trolley to reduce the strain on your hip and shoulders while hanging out the clothes.Dry heavy items on a clothes rack /radiator if necessary

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In the kitchen, place items that you use regularly at bench height so that you don’t have to do unnecessary bending or reaching

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If using heavy saucepans or pans, draw them close to you first and lift with two hands. To lessen the weight, let them rest on the sink as you drain the contents

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Don’t start new projects such as painting a skirting board or projects involving heavy lifting until your hip has recovered. Get help to carry heavy loads or to do heavy tasks

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In the garden, vary your activities and positions. Do some weeding then some raking, then some trimming. Rotate your activities

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Weed the garden kneeling on your hands and knees or in a half kneeling position with one knee bent up

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Use a wheelbarrow to take weeds to the compost bin

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Your Sleeping Posture

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See previous advice regarding pillow placement

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Exercise

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Act as usual: It is normal to experience some discomfort during recovery but don’t stress your hip to a painful level. Try to participate in most of your normal activities. If your normal activities or sports place high strains on your hip, adapt them or build up to them gradually as your hip recovers

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Be active: Perform general exercise and activity to maintain your well being and health. Undertake a specific exercise regime to improve your movement and flexibility and restore muscle control and support to your hip

* Walking is a very good form of general exercise. You need good supportive shoes with

good shock absorbing insoles. Trainers are good for walking on dry flat surfaces and

have some of the best shock absorbing material in the soles of the shoes. You should

walk at a normal pace that you are comfortable with and walk for about 30-40 minutes

3-4 times a week. Too much walking might aggravate an uncomfortable hip so try

to keep within limits and do not cause pain. When you come home do some of the

stretches below

* The best all-around exercise for the hip is swimming. The water reduces the body weight

going through your legs and relieves the stress on your hip as you “walk” about in the

shallow end of the pool. Swimming is excellent – it involves the use of most of your

body muscles. However avoid breaststroke legs as this can aggravate the hip

* Bicycling (stationary or mobile) is also a good form of exercise as it works the leg

muscles to make them strong but full body weight does not go through the legs.

»» Be adaptable: It is good for you to undertake your normal physical exercise, but you may have

to change how you exercise in the recovery phase. Some examples:

* Swimming: Do not undertake breaststroke as this is not a good position for your hip,

walking in water

* Riding a bike (stationary or mobile): lift up the handle bars so you can ride with a better

posture for your back and hip, ensure correct saddle height(see previous advice for

details)

* Running: brisk walk (use ankle weights) or if you must run, run on grass at a park rather

than on the hard surface of the road

* At the gym: seek advice from your health professional or trainer on how to change your

program to prevent strain on your hip

»» Undertake the hip rehabilitation exercises. The exercises in this leaflet were chosen specifically

to assist you to improve your level of hip movement and flexibility. The exercises will also help

restore the muscle control necessary to support your hip during normal activities. Muscle

control means pain control. Exercise to reduce your pain.

• If you are overweight, then look to reduce stress on the hip by losing weight. Use a combination of

both healthy diet and increased exercise. Please seek medical /professional support if you feel that

2.Grab hold of your foot with the hand of the same side and pull your heel nearer to your bottom until you feel a comfortable stretch on the front of the thigh

Hold the stretch for 30 seconds, return to the start position and repeat

Once you have done this repeat on the other side

HAMSTRING STRETCH

The hamstring is the large muscle at the back of the thigh.It actually attaches to your pelvis and

then below the knee at the top of the shin bone. This muscle group, comprising of 3 muscles,

both moves and stabilises the hip and the knee.

1.Whilst standing, place one foot on a small step or stool and then whilst keeping your back

straight and your head up (fix your gaze high on the wall opposite) lean forwards until you feel a

stretch in the back of the thigh

Hold the stretch for 30 seconds, return to the start position and repeat

Once you have done this repeat on the other side

Please remember to keep the back upright and straight whilst performing this exercise. Keeping

your back straight is helped by keeping your gaze high.

STRETCHING THE INSIDE OF THE THIGH / HIP

This simple exercise will stretch the tissue around the inside of the hip and thigh and maintain

the movement in this area. Although this may seem like just a hip exercise, some of the muscles

attach on the inside of the knee so you may feel a stretch here as well.

1.Stand with a wide stance

2.Lean towards one side creating a straight leg on the opposite side

3.You should feel a stretch along the inside of the leg

Hold the stretch for 30 seconds, return to the start position and repeat

Once you have done this repeat on the other hip

Please remember to keep the back upright whilst performing this exercise.

STRETCHING THE OUTSIDE OF THE HIP

This simple exercise will stretch the tissue around the outside of the hip and buttock and

maintain the movement in this area.

1.Lay down on your back with your knees bent and your feet on the surface.

2.Cross one leg over the other so that the foot is resting on the knee of the other leg. Let your

crossing leg relax so that the knee drops sideways

3.Reach forward with both hands and pull the thigh of the ‘crossed’ leg towards you until you feel a comfortable stretch in the buttock/hip of the crossing leg

Hold the stretch for 30 seconds, return to the start position and repeat on the other leg

HIP LOOSENING EXERCISES

LEG SLIDES

A gentle hip and knee movement to get you moving when feeling very stiff

Lie on your back on your bed or floor with straight legs

Slowly slide one leg up to bend your hip and knee, keep your foot on the bed

Then slowly slide it back down again to its original position

Repeat the movement on each leg 5 -10 times and do the exercise 3 times a day

KNEE AND HIP SIDEWAYS PIVOT

A gentle hip and knee movement to get you moving when feeling very stiff, pairs well with the leg slides

Lie on your back on your bed or the floor with both feet together

Slowly pivot one knee out to the side a short distance,keeping your feet on the bed

Then slowly return it back to its original position

Repeat the movement on each leg 5 -10 times and do the exercise 3 times a day.

HIP AND KNEE HUGGING

This is a great, general exercise for the hip which will help to maintain the movement in the joint whilst also stretching the muscles around the back of the hip joint.

Lie on your back with your legs straight and your back in a slightly arched position

Lift one leg towards your chest, bending at the knee and hold it there at the end of the movement or until a gentle stretch is felt

Hold the stretch for 30 seconds and repeat

Then repeat on the other hip

Please remember to do this exercise slowly and stop if you feel any pinching in the front of the hip.

STRETCHING THE FRONT OF THE HIP

Again, this is a great, general exercise for the hip which will help to maintain the movement in the joint whilst also stretching the muscle in the front of the hip.

When you sit regularly or perform repetitive activities such as walking or running, the ligaments and muscles at the front of the hip canget tight, which can lead to pain and stiffness in the front of the hip.

This simple exercise stretches the ligaments and muscles in the front of the hip and also helps to maintain the movement in the hip joint.

Place a stable chair in front of a wall so that it cannotmove

Stand in front of the chair and place the unaffected foot onthe chair

Bring your weight forward as you extend the hip of thestanding leg as far as you can

Hold the stretch for 30 seconds, return to the start positionand repeat

Once you have done this repeat on the other hip

Please remember to keep the back upright whilst performingthis exercise.

EXERCISES FOR MUSCLECONTROL AND PAIN RELIEF

KNEELING LEG SLIDES

This is a gentle exercise that works your hip flexors andextensors with minimal effort.

Kneel on your hands and knees on the floor or stable surface- place your hands right under your shoulders and you knees under your hips

Make sure that your weight is evenly balanced between handsand knees

Slowly slide your right leg backwards along the floor andbring it back again

Repeat this with your left leg

Repeat this exercise 5-10 times with each leg.

BRIDGING

This exercise will help to strengthen your buttocks and coremuscles which are very important in

hip extension and walking.

Lie on your back with knees bent and feet on the floor

Slowly curl your back off the floor hold for 3 seconds

Curl back down to the floor

Repeat this exercise 10 times

To progress this exercise, place the fingertips of bothhands on your pubic bone and then slide

them left and right along the pelvic bone until you find abig bony lump (with each hand) above

your hips. In fact we generally put our hands here when weput our hands on our hips! Place two

fingers on each bony prominence. Your aim is to keep thesebones stable as you curl your back

off the floor and also as you curl it back down!

HIP SIDE LIFT

Maintaining the strength around the hip is very importantand people are often surprised to find

that the strength around their hip may not be as good asthey expected.

Lie on your side, on a comfortable surface with both legsslightly bent at the knee

Place your upper hand over your pelvis to maintain itsposition during the exercise – do not roll

backwards

Lift up the top leg keeping the knee slightly bent, footfacing forward and the pelvis stable

You may feel the muscles working on the outside of the hip

Return to the start position and repeat 5 times

Make sure that you stay on your side and do not rollbackwards

Once you have done this repeat on the other side

HIP FLEXION

Hold on to a chair or table and lift your knee up to thelevel of you hip

Do not lift too high or cause any pain

Do the movement 5-10 times on each leg

Please remember to use this advice under the guidance of your Physiotherapist.

Mark Fletcher MCSP HCPC(PT) ACPOHE is a SeniorChartered Physiotherapist and the Clinical Director of Physio Med. Mark hasworked for the NHS and was the lead Physiotherapist to the Bradford Bulls SuperLeague club before forming Physio Med. Physio Med have been delivering qualitycare across the UK for 24 years.

To find out even more about hip problems, visit the ‘Know Your Body’ section of Physio Med's site.